Provider Demographics
NPI:1033635982
Name:BOUVATTE, KATHERINE LIN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LIN
Last Name:BOUVATTE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:LIN
Other - Last Name:KESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:824 COLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4118
Mailing Address - Country:US
Mailing Address - Phone:314-306-5955
Mailing Address - Fax:
Practice Address - Street 1:12125 WOODCREST EXECUTIVE DR STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5009
Practice Address - Country:US
Practice Address - Phone:314-275-8599
Practice Address - Fax:314-275-8299
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170051141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical